Week Two – Sunday's Blog

/in /by CAMTA

The first half of the Week 2 team arrives in a bus at the Un Canto a la Vida Hospital at 8:30AM. The team unloads hockey bags containing medical equipment and supplies required for the week. As we enter the hospital, we are greeted by applause and “buenos dias” by dozens of new and former patients and their families. It's the perfect start for the week, as the appreciation and gratitude from the families further energizes the team! It also signifies the magnitude of the impact that CAMTA has had over the last 14 years in improving quality of life for those receiving treatments, and also their families.  

Patients and families greet the CAMTA week 2 team 

 The team with hockey bags full of essential supplies for the week

The CAMTA team spends the next two hours moving and unpacking the hockey bags and setting up tables and chairs in the clinic area for patient registration. We arrange rooms for the general practitioners, adult and pediatric surgeons, anesthetists, orthopedic and anesthetic residents, medical students and nurses to assess the patients. A physiotherapy pre-op training area is also established. By10:30 AM, the clinic is setup and ready for processing patients, and the second bus of CAMTA volunteers arrives at the hospital, again greeted with applause and cheers. With the entire team assembled, the day starts with a quick reminder of the workflow process from Dr. Saifee Rashiq to ensure the Clinic day operations run smoothly.

Dr. Saifee Rashiq gathers the team to explain the patient flow through the clinic

The first step of the process for all patients, whether adult or pediatric, is to complete registration. This is led by Greg Zinter and Dan Lefebvre with the assistance of a translator. Each patient is assigned a unique CAMTA identification number, and patient information along with their photograph is stored in a computer database. CAMTA sees many returning patients for follow ups, and their profiles can be quickly accessed from this database as needed. 

 Greg Zinter and Toby Cubitt (translator)  complete patient registration on Clinic Day. Orthopedic Resi

One of the first patients of the day is Carla, a 2-year old girl with left hip dislocation. Carla is a returning patient, and underwent surgery for her right hip reduction last year. Pediatric ward nurses Dianne Cortez and Julie Cadrin are excited to see Carla and her family after a year.

Pediatric Ward nurses Dianne Cortez and Julie Cadrin with 2-year old Carla and her family. Carla will undergo left hip surgery this week.

After registration is complete, Carla makes her way to a consult with pediatric orthopedic surgeon, Dr. Sumit Gupta. Translator Alexandria (Alex) Tapia assists with communication in Spanish with Carla's family. Carla's x-rays show excellent recovery on her right hip on which she received surgery last year. This year, Carla will undergo a similar surgery for her left hip. 

Pediatric Orthopedic Surgeons Dr. Sumit Gupta & Dr. Marc Moreau examine Carla's x-rays, and translator Alex Tapia assists in communication. 

After the consultation is complete, a pediatric ward nurse works with Carla and her mother to review and document information about her family medical history, vaccinations, and exposures to disease and infections. Carla's blood pressure and temperature are checked and recorded in her chart to determine that she is healthy for surgery. 

Carla's Blood Pressure is checked
After an assessment with the pediatric ward nurse, the parents are given detailed information about the anesthesia administered during the surgery, it's potential side effects, and information about food and medication to be consumed prior to the surgery. This is the last step of the Clinic Day process, and families can return home once they have met with the Anesthesiologist.  The families are contacted by a Social Worker with details of the surgery schedule. 
Pediatric Anesthesiologist, Dr. Kate Fry, and translator Adam Petriw explain the surgery process to parents so they know what to expect
Most of CAMTA's adult patients suffer from severe hip arthritis. In North America, these patients are generally 50 years or older. However, in Ecuador because primary hip pathologies often do not get treatment at a young age, the average patient is more middle-aged. Typically post-op patients in Ecuador do very well with pain management and can go home sometimes as early as the next day.
Dr. Sebastian Rodriguez (left), Dr. Rejean Cloutier (right) and medical student Sarah Roshko examine patients
After the consultation with the adult orthopedic surgeons, the patients meet with physiotherapists to learn about post-op exercises. The physiotherapists teach patients how to get in and out of cars, how to use walkers and put on socks as they are not allowed to flex past 90 degrees after hip surgery. Exercises are demonstrated and the patients also watch a video detailing this information. Post-op exercises are essential for gaining strength, hip range of motion and preventing blood clots. Typically, patients will have follow ups after surgery where physiotherapists will advise them of further advanced exercise.
 Physiotherapists (left to right) Brenda Corie, Kristen Redhead, and Judith Black educate patients about post-op excercises. Local volunteer and previous CAMTA patient, Jorge assists with translation. 
Physiotherapist Brenda Corie teaches a patient how to use a walker
All adult patients are asked to fill out a Quality of Life questionnaire prior to their first hip surgery and each year they come back to the clinic for follow up. This questionnaire covers many aspects such as the patients eating, sleeping habits and general well being. Looking at pre-op and post-op data helps the CAMTA team understand the direct impact the treatment has had on the patient's daily life.
Marta Mora (translator) with Alyssa Chappell (layperson) and and Lisa Bleackley (Adult Ward Nurse) explain how to fill out  the pre-op Quality of Life questionnaire 
Not everyone who comes to the CAMTA clinic can be helped. Pre-existing health conditions could make some surgeries too risky or complicated for the team to execute with the resources and facilities available to us. At the end of the day, the team compiles a list of surgeries for the week. By 5 PM the last patient has been seen.

 The week 2 clinic day has been very successful with 11 pediatric and 20 adult surgeries on the schedule for the week. As word spreads about CAMTA and new cases come up, it's quite common for more people to show up for consult throughout the week, bringing some changes to the preliminary surgery schedule. The schedule is adapted to accommodate the changing dynamics. At the end of the day, 2 pediatric surgeries, and 4 adult surgeries are scheduled for Monday.

CAMTA team members Dan Lefebvre, Aline Young, Sandra Muchekeza and Greg Zinter help collect paperwork and supplies during the cleanup. Supplies are loaded on a stretcher to transport to another floor.

 The team gathers back in the clinic area where we started the day, and now we clear everything out of the main floor. The tables, chairs and all other equipment we had setup in the morning for the day's clinic is returned to its original location in the hospital.  We board the bus back to the hotel at 6:30PM. It's been a wonderful first day!